{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T23:52:00Z","timestamp":1793922720334,"version":"4.8.0"},"reference-count":9,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,8,10]]},"abstract":"<jats:p>Hepatic hydrothorax refers to the presence of a pleural effusion (usually &gt;500\u2009mL) in a patient with cirrhosis in whom other causes of pleural effusion, such as cardiopulmonary causes, pleural disease or malignancy have been excluded. It is seen in 5%\u201310% of patients with end-stage liver disease. A subset of these patients can develop infection of the hepatic hydrothorax, called spontaneous bacterial empyema. They may present with fever, chills and dyspnoea. We present the case of an 83-year-old man with a history of cirrhosis who developed a large right-sided pleural effusion, confirmed to be empyema by pleural fluid analysis. We aim to highlight the occurrence of spontaneous bacterial empyema. While less common that spontaneous bacterial peritonitis as a complication of cirrhosis, it is equally serious with potential for adverse outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2018-224810","type":"journal-article","created":{"date-parts":[[2018,8,29]],"date-time":"2018-08-29T12:10:19Z","timestamp":1535544619000},"page":"bcr-2018-224810","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Spontaneous bacterial empyema: an elusive diagnosis in a patient with cirrhosis"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2714-5923","authenticated-orcid":false,"given":"Sarthak","family":"Soin","sequence":"first","affiliation":[{"name":"Internal Medicine, Presence Saint Joseph Hospital Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nehan","family":"Sher","sequence":"additional","affiliation":[{"name":"Internal Medicine, Presence Saint Joseph Hospital Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasir","family":"Saleem","sequence":"additional","affiliation":[{"name":"Internal Medicine, Presence Saint Joseph Hospital Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,8,29]]},"reference":[{"key":"2025082723075380000_2018.aug29_1.bcr-2018-224810.1","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/MCP.0b013e328352b50f","article-title":"Spontaneous bacterial empyema","volume":"18","author":"Tu","year":"2012","journal-title":"Curr Opin Pulm Med"},{"key":"2025082723075380000_2018.aug29_1.bcr-2018-224810.2","first-page":"579","article-title":"Risk factors for spontaneous bacterial empyema in cirrhotic patients with hydrothorax","volume":"66","author":"Chen","year":"2003","journal-title":"J Chin Med Assoc"},{"key":"2025082723075380000_2018.aug29_1.bcr-2018-224810.3","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/j.1478-3231.2010.02447.x","article-title":"Outcome predictors of cirrhotic patients with spontaneous bacterial empyema","volume":"31","author":"Chen","year":"2011","journal-title":"Liver Int"},{"key":"2025082723075380000_2018.aug29_1.bcr-2018-224810.4","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.gastrohep.2012.04.007","article-title":"Spontaneous bacterial empyema in a cirrhotic patient due to Clostridium perfringens: case report and review of the literature","volume":"36","author":"Albuquerque","year":"2013","journal-title":"Gastroenterol Hepatol"},{"key":"2025082723075380000_2018.aug29_1.bcr-2018-224810.5","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840110306"},{"key":"2025082723075380000_2018.aug29_1.bcr-2018-224810.6","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510230410"},{"key":"2025082723075380000_2018.aug29_1.bcr-2018-224810.7","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1016\/j.amjmed.2014.01.034","article-title":"Spontaneous bacterial empyema: not your average empyema","volume":"127","author":"Lam","year":"2014","journal-title":"Am J Med"},{"key":"2025082723075380000_2018.aug29_1.bcr-2018-224810.8","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1055\/s-0030-1269829","article-title":"Pleural effusion in liver disease","volume":"31","author":"Alonso","year":"2010","journal-title":"Semin Respir Crit Care Med"},{"key":"2025082723075380000_2018.aug29_1.bcr-2018-224810.9","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.cld.2014.01.005","article-title":"Hepatic hydrothorax","volume":"18","author":"Norvell","year":"2014","journal-title":"Clin Liver Dis"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-224810","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:08:04Z","timestamp":1756361284000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-224810"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,29]]},"references-count":9,"alternative-id":["10.1136\/bcr-2018-224810"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-224810","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,29]]}}}